Provider Demographics
NPI:1407095870
Name:MOTTA, GABRIELA A (PT)
Entity Type:Individual
Prefix:MS
First Name:GABRIELA
Middle Name:A
Last Name:MOTTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SW 73RD ST
Mailing Address - Street 2:CHILD DEVELOPMENT CENTER
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4679
Mailing Address - Country:US
Mailing Address - Phone:786-662-5080
Mailing Address - Fax:786-662-5081
Practice Address - Street 1:6200 SW 73RD ST
Practice Address - Street 2:CHILD DEVELOPMENT CENTER
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4679
Practice Address - Country:US
Practice Address - Phone:786-662-5080
Practice Address - Fax:786-662-5081
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24333225100000X
MA16745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1982688230OtherHOSPITAL NPI NUMBER
FL010058700Medicaid